Surveillance Imaging for Head and Neck Cancer: The Rise of NIRADS

This educational presentation introduces NIRADS (a four-point ACR-sponsored scoring system similar to BI-RADS) for head and neck cancer surveillance imaging. The speaker explains when and why to perform surveillance imaging after definitive treatment, comparing different imaging modalities including ultrasound, CT, MRI, and PET CT. The University of Pittsburgh's surveillance protocol is detailed, starting with imaging 2-3 months post-treatment and continuing every 3-6 months for two years. The core focus is on NIRADS implementation, where scores 1-4 correspond to specific clinical recommendations: routine surveillance, short interval follow-up, biopsy, or treatment respectively. Multiple PET CT case examples demonstrate proper NIRADS scoring, showing how the system effectively risk-stratifies patients with high predictive values (90% negative predictive value for NIRADS 1, 60% positive predictive value for NIRADS 3). The presentation concludes with a personalized surveillance algorithm that adjusts follow-up timing based on NIRADS scores, potentially stopping imaging after two consecutive negative scans while maintaining high cure detection rates.